The Art of Medicine

D Nageshwar Reddy MD, DM, DSc, FAMS, FRCP, FASGE, FACG, MWGO

Asian Institute of Gastroenterology. Hyderabad, India.

SRI VENKATESWARA INSTITUTE OF MEDICAL SCIENCES

TIRUPATI, ANDHRA PRADESH,INDIA

10th CONVOCATION - 29.02.2020

Sir Luke Fildes' - The Doctor (1887)

Medicine = Art + Science + Empathy

The Secret of the Care of Patient is in Caring for the Patient Francis Peabody (1881-1922)

“The art of medicine consists

in amusing the patient while

nature cures the disease”

Voltaire (1694 –1778)

Medical diagnosis

• 98% → Post mortem

Diagnosis

• 92% → investigations

• 84% → Examination

• 80% → symptoms

• Studies have shown that human life expectancy

mainly depends on food,immunisation clean

drinking water and sanitary facilities in addition

to education and economic empowerment and

very little on hi tech medicine

Challenges in Medical Practice (EBM)

Evidence Based Medicine

vs

Experienced Based Medicine

Smith and Pell. BMJ 2003

Gordon CS Smith et al BMJ 2003

Pain killers story

NSAID

Use No bleed Cox2

Banned in many countries Heart attacks

Journal of pain (American Pain Society)(2000) Daily doses of raw or heat treated ginger ↓ muscle joint pains

GI bleed

• Mind is best pain reliever

• Most powerful drugs in the world are “two kind

words from a good doctor”

• The state of cancer science : of 53 notable

studies on cancer in the last 5 years only 11%

could be replicated and reproduced.

• 89% of the papers were funded by the industry

Dilemma for the doctors

How vs Why

“Positive science cannot answer the question why, they can at best answer

“how” or how much, but not why”

Charles Sherrington Nobel Laureate in Medicine

“A wise man knows he is a fool, but a fool always thinks he is wise”

Always be humble

Michelangelo Buonarroti. Pietà Rondanini (1564). Castello Sforzesco. Milano, Italy.

“I am still learning,”

the 88-year-old Michelangelo

scribbled on the margin of a

sketchbook as he was

working on his last unfinished

masterpiece, the Pietà

Rondanini

San Diego

Hongkong

Beijing

Michel Cremer: Pioneer in Pancreatic Endotherapy

Persistence & Honesty

Forceps for delivery

• Peter Chamberlen (1575 – 1628)

• 1817 – secret revealed • 1930 – 1 / 150 pregnancy death • 1950 – 1 / 1000

• New born deaths – 1 / 30

APGAR score changed this

Aristotle

“Excellence is an art won by training and

habituation.

We do not act rightly because we have

Virtue or Excellence, but we rather have

those because we have acted rightly.

We are what we repeatedly do.

Excellence, then, is not an act but a habit.”

“Perfection without Practice”

British Audit Report

They should be no learning curve as far as safety is concerned

Endoscopic Training

We look for medicine to be an orderly field of knowledge and

procedure. But it is not. It is imperfect science, an enterprise of

constantly changing knowledge, uncertain information, fallible

individuals, and at the same time lives on the line. There is science in

what we do, yes, but also habit, intuition, and some times plain old

guessing. The gap between what we know and what we aim for

persist. And this gap complicates every thing we do.

Medicine is not now, and never has been,

an exact science. Despite the exercise of

the greatest skill, things can go wrong

Scream Edvard Munch

1893 - 1910

The art of breaking news of a complication

“ Doctors are wonderful. Up until the last few years, unfortunately

they received virtually no training in medical school on how to

communicate bad outcomes to patients ”

“ They are taught everything under the sun clinically and

academically, but nobody teaches them the softer side of

medicine ”

David Sousa, Sr. VP, Medical Mutual Insurance Company of

North Carolina

Checklist nurse

Successful people don’t do

different things, they to

things differently

Shiv Khera

3 kind of people

• People who make thing happen

• People who watch thing happen

• People who wonder what happened

Real success come to doers….. not observers

The winner has a solution for every

problem ,the loser has a problem for

every solution

• If you think you can, you can

• If you think you cannot, you cannot

• You are right either way

Success is not an accident it is the result of an attitude

Goals

S

M

A

R

T

– specific

– measurable

– achievable

– realistic

– time bound

Good doctor

Successful doctor

Talent × effort = skill

Skill × communication = achievement

“The hands that help are holier

then the lips that pray”

Work vs

Glass Ball Rubber Ball

Family Friends Health

Team AIG